Moderators and mediators among panic, agoraphobia symptoms, and suicidal ideation in patients with panic disorder
published online 31 August 2009.
Abstract
Objectives
The most important change of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) is the use of dimensional approach to assess the severity of symptoms across different diagnosis. There are 2 purposes in this study: the first purpose was to identify the proportion of outpatients with panic disorder who have suicidal ideation. The second aim was to examine the relationships among panic, agoraphobic symptoms, and suicidal ideation in patients with panic disorder, adjusting by age, social support, and alcohol use.
Methods
Sixty patients with panic disorder were recruited from outpatient psychiatric clinics in southern Taiwan. Suicidal ideation in the preceding 2 weeks was measured. The Panic and Agoraphobic Symptoms Checklist, Social Support Scale, Questionnaire for Adverse Effects of Medication for Panic Disorder, and Social Status Rating Scale were used to understand the severity of panic and agoraphobia, social support, drug adverse effects, and social status. Significant variables from the univariate analysis were included in a forward regression model. Then, we used structural equation modeling to fit the model.
Results
We found that 31.7% of outpatients with panic disorder had had suicidal ideation in the preceding 2 weeks. Multiple regression analysis showed that younger age, current alcohol use, more severe panic symptoms, and less social support were associated with suicidal ideation. In addition, the structural equation model illustrated the recursive model from panic to agoraphobia and suicidal ideation. Agoraphobia had no association with suicidal ideation. Panic symptom was a mediator to suicidal ideation but not agoraphobic symptoms.
Conclusions
A high proportion of patients with panic disorder had suicidal ideation. We found that panic symptoms, social support, age, and alcohol use affected suicide and could be identified. The 3-level model from panic to agoraphobia revealed that panic was a predictor of agoraphobia and agoraphobia was not a predictor of panic. This verified the evolution of the diagnostic view of the DSM. Panic symptom was a mediator to suicidal ideation. With the dimensional model in DSM-V, panic symptoms can be used as a marker for greater morbidity and severity.
aDepartment of Psychiatry, Kai-Suan Psychiatric Hospital, Kaohsiung, 802 Taiwan
bDepartment of Psychiatry, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, 807 Taiwan
cDepartment of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, 809 Taiwan
dDepartment of Psychiatry, Kaohsiung Armed Forces General Hospital, Kaohsiung, 802 Taiwan
eGraduate Institute of Behavioral Sciences, Kaohsiung Medical University, Kaohsiung, 807 Taiwan
fDepartment of Psychiatry, National Defense Medical Center, Taipei, 114 Taiwan
gCalo Psychiatric Center, Pingtung County, 925 Taiwan
Corresponding author. Department of Psychiatry, Kaohsiung Armed Forces General Hospital, Kaohsiung city 802, Taiwan. Tel.: +886 7 749 0056; fax: +886 7 749 3767.
ABSTRACT